CYP2C19、SLCO1B1和APOE基因检测用于PCI术后患者的经济性评价  

Economic Evaluation of CYP2C19,SLCO1B1 and ApoE Gene Detection in Patients after PCI

作　　者：徐晓红 严婧雯 陈君君 韩永龙[1] 杨姣[1,3] Xu Xiaohong;Yan Jingwen;Chen Junjun;Han Yonglong;Yang Jiao(Shanghai Jiao Tong University Affiliated Sixth People’s Hospital,Shanghai 201306,China;Shanghai University of Medicine&Health Sciences;Shanghai Sixth People’s Hospital East Affiliated to Shanghai University of Medicine&Health Sciences)

机构地区：[1]上海交通大学附属第六人民医院,上海201306 [2]上海健康医学院 [3]上海健康医学院附属第六人民医院东院

出　　处：《药物流行病学杂志》2021年第6期392-397,共6页Chinese Journal of Pharmacoepidemiology

基　　金：国家自然科学基金项目(编号:82003987);上海市卫生和计划生育委员会中医药科研课题(编号:2018YP003);上海市浦东新区科技发展基金民生科研专项资金项目(编号:PKJ2020-Y08);中国药学会全国医药经济信息网科技传播创新工程(编号:CME12019KPYJ00421);上海市第六人民医院医疗集团课题。

摘　　要：目的:评估CYP2C19、SLCO1B1和APOE基因检测对经皮冠状动脉介入治疗(PCI)术后患者药物治疗的经济性,探讨临床药师根据基因检测参与患者个体化药物治疗的必要性和切入点。方法:回顾性收集2018年8月~2020年10月在我院PCI术后使用氯吡格雷和他汀类药物治疗冠心病的住院患者,根据是否行CYP2C19、SLCO1B1和APOE联合基因检测,将患者分为检测组(n=40)和未检测组(n=54)。观察检测组基因分布情况及临床用药调整情况;比较两组患者出院后1年内再入院率,并进行成本-效果分析。结果:根据基因检测结果:CYP2C19基因型中需调整用药20例,实际调整3例(15.0%);SLCO1B1基因型中需调整用药0例;ApoE基因型中需调整用药6例,实际调整1例(16.7%)。检测组和未检测组PCI术后1年内再入院率分别为9.1%和25.0%(P<0.05),且调整用药患者出院后1年内再入院率为0%。两组人均总治疗金额比较无明显差异(P>0.05);但检测组患者氯吡格雷和他汀类药物平均成本明显低于未检测组(P<0.05)。检测组具有成本-效果优势,增量成本-效果比为68.6。结论:依据基因检测调整用药可明显降低患者PCI术后1年内再入院率,减少药物治疗成本,具有成本-效果优势。临床药师根据基因检测参与个体化药物治疗存在必要性。Objective:To evaluate the economic efficiency of CYP2 C19,SLCO1 B1 and ApoE genetic testing for drug therapy for patients after percutaneous coronary intervention(PCI),and to discuss the necessity and entry point for clinical pharmacists to participate in individualized drug therapy for patients according to genetic testing.Methods:The hospitalized patients who received clopidogrel and statins for coronary heart disease after PCI in our hospital from August 2018 to October 2020 were retrospectively collected.The patients were divided into the tested group(n=40)and the untested group(n=54)based on whether CYP2 C19,SLCO1 B1 and ApoE combined testing was performed.The gene distribution and clinical medication adjustment of the test group were observed.The readmission rate within one year after discharge was compared between the two groups.Simultaneously,the cost-effectiveness analysis was conducted.Results:According to gene test results,20 cases of medication need to be adjusted and 3 cases actually adjusted(15.0%)in the CYP2 C19 gene detection.In the SLCO1 B1 gene test,0 cases needed to be adjusted.In the ApoE gene test,6 cases needed to adjust the medication,and 1 case actually adjusted(16.7%).The readmission rate within one year after PCI were 9.1%in the tested group and 25.0%in the untested group(P<0.05),respectively.The readmission rate within 1 year after discharge in patients with adjusted medication was 0%.There was no significant difference in the total amount of treatment per capita between the two groups(P>0.05).However,the average cost of clopidogrel and statins in the tested group was significantly lower than that in the untested group(P<0.05).The tested group had the cost-effectiveness advantage,and the incremental cost-effectiveness ratio was 68.6.Conclusion:Adjust medication according to genetic testing could significantly reduce the readmission rate within 1 year after PCI and the cost of drug therapy,which shows a cost-effectiveness advantage.It is necessary for clinical pharmacists to participate

关 键 词：CYP2C19 SLCO1B1 APOE 基因检测 经皮冠状动脉介入治疗 氯吡格雷 他汀类药物 成本-效果分析 

分 类 号：R968[医药卫生—药理学]